Screening Uptake and Diagnostic Yield of One-time Fecal Immunochemical Testing Vs One-time Colonoscopy for Colorectal Cancer: a Systematic Review and Meta-analysis.

BACKGROUND

Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide. In recent years, its incidence has been increasing among younger populations. Screening methods such as colonoscopy and fecal immunochemical testing (FIT) are widely used to detect colorectal neoplasms. This systematic review and meta-analysis compare the screening uptake and diagnostic yield of one-time FIT versus a one-time colonoscopy for detecting CRC, non-advanced adenomas, and advanced adenomas.

METHODS

Databases (including MEDLINE, EMBASE, and CENTRAL) were searched for studies published up to November 1, 2024, that directly compared FIT and colonoscopy for CRC screening. Cochrane's Risk of Bias tool (RoB 2.0) was used for quality assessment. Risk ratios (RR) for screening uptake and odds ratios (OR) for diagnostic yield were calculated using an intention-to-screen analysis with a random-effects model. Heterogeneity was assessed using I2 statistics.

RESULTS

Eleven randomized controlled trials (RCTs) with 207,347 participants were included. The intention-to-screen analysis showed a significantly higher screening uptake for one-time FIT compared to one-time colonoscopy (RR = 1.68; 95% CI, 1.43-1.99; P < 0.01). FIT had an inferior diagnostic yield for non-advanced (OR = 0.18; 95% CI, 0.13-0.24; P < 0.01) and advanced adenomas (OR = 0.47; 95% CI, 0.36-0.61; P < 0.01). No significant differences were observed between the two methods in detecting CRC (OR = 0.77; 95% CI, 0.48-1.25; P = 0.29).

CONCLUSIONS

A one-time FIT results in higher screening uptake and comparable CRC detection compared to one time colonoscopy, but it has a lower diagnostic yield for both non-advanced and advanced adenomas. Since this analysis focuses on a single FIT test, further studies are needed to determine whether annual or biennial FIT screening compensates for its lower diagnostic yield over time.

TRIAL REGISTRATION: PROSPERO CRD 42024606884.